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Hirata, Yuki, Hirofumi Kawakubo, Shuhei Mayanagi, Kazumasa Fukuda, Rieko Nakamura, Koichi Suda, Norihito Wada, and Yuko Kitagawa. "PS01.174: AN EXAMINATION OF OUTCOMES AFTER ANTE-THORACIC ROUTE WITH RIGHT HEMICOLON RECONSTRUCTION AFTER ESOPHAGECTOMY." Diseases of the Esophagus 31, Supplement_1 (September 1, 2018): 99. http://dx.doi.org/10.1093/dote/doy089.ps01.174.
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Abstract Background In our institute, we usually use gastric tube for reconstruction organ after esophagectomy. When we can’t use gastric tube, we use right hemi-colon with ante-thoracic route. Previously, we reconstructed by 1-step after esophagectomy, but from 2012, we have done by 2-step for reduce postoperative complications. Methods We enrolled 15 esophageal cancer patients who underwent esophagectomy and right hemicolon reconstruction between April 2004 and December 2016. Results The average age of 15 patients is 67.3. The reasons of using right hemicolon are as follows; post gastrectomy 13, stomach double cancer 2. The reasons of gastrectomy are as follows; gastric cancer 8, duodenum cancer 1, gastric ulcer 4. The average duration from gastrectomy to esophagectomy is 12.5 year. We reconstructed by 1-step for 5 patients, and after 2012, we reconstructed by 2-step for 10 patients. Anastomotic leakages were found in 2 cases (40.0%) in 1-step reconstruction group, and 3 cases (20.0%) in 2-step reconstruction group. In 1-step reconstruction group, 1 case occurred multiple anastomotic leakages and DIC, and another 1 case was found necrosis of reconstructive colon. In 2-step reconstruction group, we found 1 case of major leakage and 1 case of recurrent nerve paralysis and 2 cases of postoperative pneumonia. However, there were no case of tracheotomy. The incidence of pneumonia did not differ between the two groups. And the term of postoperative oral intake tend to shorter in 2-step reconstruction group (P = 0.06). 2 severe postoperative complications (Clavian-Dindo V or IVa) cases were found in 1-step reconstruction group, on the other hand, 2 cases severe complications (CD IIIa) in 2-step reconstruction group. Conclusion In the case of using right hemicolon as a reconstructive organ, 2-step reconstruction approach is useful and superior from the viewpoints of postoperative complications. Disclosure All authors have declared no conflicts of interest.
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Kayal, Neeraj, Vineet Nair, and Chandan Saha. "Average-case linear matrix factorization and reconstruction of low width algebraic branching programs." computational complexity 28, no. 4 (July 18, 2019): 749–828. http://dx.doi.org/10.1007/s00037-019-00189-0.
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Buta, Martin, Matthew DePamphilis, Branko Bojovic, and Daniel N. Driscoll. "88 Pediatric Postburn Ear Reconstruction of Significant Cartilage Defects." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S58—S59. http://dx.doi.org/10.1093/jbcr/irac012.091.
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Abstract Introduction The ear is a protruding appendage with multiple functional and aesthetic implications. Literature indicates that up to 40-60% of facial burns involve the ear. Ear burns with considerable tissue loss and sensory deficits can negatively impact quality of life, psychosocial functioning, and physical health. Successful ear reconstruction mitigates these undesirable outcomes. The complex architecture of the external ear presents a formidable surgical challenge after burn injury, when scar tissue, impaired blood supply, and trauma to cartilage all influence reconstructive options. A lack of materials that truly replicate the characteristics of uninjured elastic cartilage also presents a longstanding surgical dilemma. In this retrospective study, the authors highlight the utility of reconstructive techniques to address significant cartilage deficits, including conchal transposition flap, composite graft, costal cartilage graft, and porous polyethylene implant. Methods A retrospective review was conducted on patients aged 0 to 21 years who underwent cartilage framework reconstruction between January 2004 to January 2021 at a specialized pediatric burn center. Medical records from the hospital’s patient database were screened, and 52 patients (60 ears) who met study criteria were identified. Patient demographics, procedural characteristics, and patient outcomes were analyzed. Results For helical rim cartilage defects, 20 patients (23 ears) with an average age of 15 ± 4 years underwent a conchal transposition flap, which was associated with no major complications. In cases involving repair of small to medium cartilage deficits, 9 patients (9 ears) with an average age of 13 ± 5 years underwent a composite graft, which was associated with one case of infection. A total of 20 patients (23 ears) with an average age of 13 ± 6 years underwent porous polyethylene implantation, which was associated with two cases of exposure and one case of infection. Of these porous polyethylene cases, 20 ears involved helical rim reconstruction and 3 involved total ear reconstruction. Costal cartilage grafting was performed in 4 patients (5 ears) with an average age of 13 ± 5 years and was associated with one case of infection. Costal cartilage grafting was utilized to reconstruct 2 helical rims and 3 total ears. Conclusions In cases of focal cartilage defects or medium-sized helical rim cartilage loss, highly aesthetic results and minimal complication rates can be achieved with composite graft or conchal transposition flap. When presented with large to total helical rim loss or total ear loss, either costal cartilage graft or porous polyethylene implantation is typically necessary.
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Adil, Dehhaze, Taybi Otmane, Diher Issam, Daghouri Nada-Imane, Labbaci Rim, Echmilimouad a, Tazi Hanae, and Tita Sara. "LIP CANCER: DEFECT RECONSTRUCTION CHALLENGE (A REVIEW OF 6 CASE)." International Journal of Advanced Research 10, no. 07 (July 31, 2022): 324–36. http://dx.doi.org/10.21474/ijar01/15037.
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Lip cancer is a frequent tumor of the head and neck region. Surgery is the treatment of choice for most of these cancers. Although there are several strategies to reconstruct lip tumors after tumor ablation this reconstruction is a challenge for the plastic surgeon. A retrospective review of the patients treated for lip cancer in the plastic reconstructive and esthetic Surgery Department of CHU TTA (Tangier-Tetouan-Al Hoceima), from march 2021 to June 2022. Only patients with histological confirmation of lip cancer were included. All the cases were evaluated for demographic features, tumor characteristics, and lip reconstructive surgery used. There were 4 male and 2 female patients. (4:2 ratio). with an average age of 57 years. the lower lip was the most frequently affected (83%), Most tumors were squamous cell carcinomas in 4 cases (83 %) a basal cell carcinoma (BCC) in 1 case (17%), and were located in the lower lip in 4 cases (83 %). Neck dissection was performed in 3 cases (50. Different surgical techniques were used for lip reconstruction after tumor ablation: a V-shaped wedge excision and direct repair was performed in 1 case (17 %) W-shaped wedge excision in 1 case (17%) V-shaped wedge in the upper lip associated with w shaped wedge in the lower lip in one 1 patient (17%) and karapandzic flap is performed for 3 patients (50 %).The most significant aspect of lip cancer surgery is tumor ablation, and that is not affected by the subsequent reconstructive strategy. Careful preoperative assessment and planning will allow the surgeon to reach an acceptable balance between form and function with the reconstruction.
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Bassiony, Ayman Abdelaziz. "Giant Cell Tumour of the Distal Radius: Wide Resection and Reconstruction by Non-vascularised Proximal Fibular Autograft." Annals of the Academy of Medicine, Singapore 38, no. 10 (October 15, 2009): 900–904. http://dx.doi.org/10.47102/annals-acadmedsg.v38n10p900.
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Introduction: Giant cell tumours of the bone are aggressive and potentially malignant le-sions. Juxtaarticular giant cell tumours of the lower end radius are common and present a special problem of reconstruction after tumour excision. Out of the various reconstructive procedures described, non-vascularised fibular autograft has been widely used with satisfactory functional results. Materials and Methods: Ten patients with a mean age of 33.4 years, with either Campanacci grade II or III histologically proven giant cell tumours of lower end radius were treated with wide excision and reconstruction with ipsilateral non-vascularised proximal fibular autograft. Host graft junction was fixed with dynamic compression plate (DCP) in all cases. Wrist ligament reconstruction and fixation of the head of the fibula with carpal bones and distal end of the ulna using K-wires and primary cancellous iliac crest grafting at graft host junction was done in all cases. Results: The follow-up ranged from 30 to 60 months (mean, 46.8). At last follow-up, the average combined range of motion was 100.5° with range varying from 60° to 125°. The average union time was 7 months (range, 4 to 12). Non-union occurred in 1 case. Graft resorption occurred in another case. Localised soft tissue recurrence occurred in another case after 3 years and was treated by excision. There was no case of graft fracture, metastasis, death, local recurrence or significant donor site morbidity. A total of 3 secondary procedures were required. Conclusions: Enbloc resection of giant cell tumours of the lower end radius is a widely accepted method. Reconstruction with non-vascularised fibular graft, internal fixation with DCP with primary corticocancellous bone grafting with transfixation of the fibular head and wrist ligament reconstruction minimises the problem and gives satisfac-tory functional results.
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Andhika Pramana, IGN Bagus, and IGN Wien Aryana. "Arthrofibrosis Following ACL Reconstruction: Case Report." International Journal of Health Sciences and Research 12, no. 3 (March 5, 2022): 149–59. http://dx.doi.org/10.52403/ijhsr.20220321.
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Introduction: Arthrofibrosis is a debilitating complication of loss of motion after ACL reconstruction following ACL injury with a reported incidence of 2% to 35%. Delayed ACL reconstruction has been the chosen management based on the suggestion from some studies of the risk reduction in developing arthrofibrosis and decreased range of motion (ROM) postoperatively. Case Presentation: A 51-year-old female presented with complaints of pain, stiffness, and decreased range of motion following a knee ligament reconstructive arthroscopy of her right knee. After unsuccessful rehabilitative management, the patient underwent additional surgical repairs. Following the surgery, a fibrous thick scar tissue located at the suprapatellar pouch and mainly over the medial and lateral gutter was observed, in which an adhesiolysis was performed during the arthroscopic procedure. Passive range of motion of the affected knee was checked intra-operatively, showing the knee to be able to fully extend and flexed passively comparable to non affected knee. An intensive physiotherapy and continuous passive motion was begun immediately post-operatively. A 33-year-old male sustained an isolated complete tear of the left knee anterior cruciate ligament. An arthroscopy ACL single bundle reconstruction surgery with patellar tendon bone graft was done four weeks after the injury. Intraoperative was uneventful. Each end of graft was stitched together with a high strength of non-absorbable suture. Graft fixations used bio absorbable screws and loaded with extracortical buttons. After post operation, patient was observed to be able to perform full active knee extension. The patient was very compliant to rehabilitation program and also performed the exercises at home. However, on clinic follow-up, the patient started to gradually loss his active full extension and on subsequent visit further affected his passive full extension (10 degrees extension lag) at 4 months post operation. Regional examination showed diffused firm swelling over the anteromedial aspect of the knee just above the medial joint line that was very tender. An intensive physiotherapy and continuous passive motion were begun immediately post operatively. Result: In the first patient, the functional outcome score showed improvement at the time of final follow-up, as well as the average pain scores. This case report emphasized on the importance of early recognition as well as assessment by the orthopaedic practitioners of arthrofibrosis as a complication of ACL reconstructive surgery is the key point in reducing the long-term morbidity caused by the condition in patients unable to regain flexibility at the expected rate after injury or surgical treatment. Rehabilitation protocols should mainly stress on early motion, rapid return of quadriceps function and excursion, and patella mobilization. The second patient, functional outcome was measured with KSS to assess pain and function after arthroscopy. The functional outcome score showed improvement from 68 points pre-operatively to 86 at the time of final follow-up. The average pain scores improved as well from 30 points pre-operatively to 41 at the time of final follow-up. Conclusion: Arthrofibrosis following ACL reconstruction represents a broad continuum of abnormalities, and hence a thorough understanding of the condition and a comprehensive approach to its management is of importance to achieve a functional result. Key words: Arthrofibrosis, Loss of motion, ACL Reconstruction, Arthroscopy.
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Danardono, Edwin. "Case Report: POST ESOPHAGECTOMY ESOPHAGEAL RECONSTRUCTION IN ESOPHAGEAL INJURY DUE TO CAUSTIC MATERIALS." Folia Medica Indonesiana 53, no. 4 (December 28, 2017): 287. http://dx.doi.org/10.20473/fmi.v53i4.7163.
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The esophageal caustic injury is rare, but it requires precise and complex management. A variety of reconstruction techniques have been done, but despite the increasing volume, the incidence of complications is still relatively high. We reported the experience in our center in handling esophageal reconstruction in patients with caustic esophageal injury that caused oesophageal stricture between 2014-2017. This study used case series method with literature review. The results showed that between 2014-2017, there were 3 patients with caustic esophageal injury. All patients undergoing esophageal reconstruction surgery were included under conditions of malnutrition. Two were caused by HCl and the rest by NaOH. All patients underwent a resection of stricture segment of the esophagus, either using partial or total esophagectomy. Anastomosis leakage occurred in all cases, but improved with conservative treatment. The average length of hospitalization was 27 days. The intraoperative blood loss in patients ranged from 450-700 cc. In conclusion, proper preliminary management can provide approppiate preparation of the patients for definitive or reconstructive surgery, especially to avoid malnutrition. The ideal reconstruction still could not be established, and the rate of postoperative complications was still high. The length of patient hospitalization was also relatively long.
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Zehir, Sinan, Nurzat Elmalı, Murat Çalbıyık, Zeki Taşdemir, and Fevzi Sağlam. "Posterior Cruciate Ligament Reconstruction Using Single-Bundle Achilles Allograft with Open Tibial Inlay Fixation." Orthopaedic Journal of Sports Medicine 2, no. 11_suppl3 (November 1, 2014): 2325967114S0020. http://dx.doi.org/10.1177/2325967114s00209.
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Objectives: PCL reconstruction research has shown that the tibial inlay and transtibial tunnel procedures offer similar biomechanical results. The purpose of this study was to evaluate the early results of PCL reconstruction using a single-bundle Achilles allograft and tibial inlay fixation. Methods: We retrospectively studied 14 patients who had undergone PCL reconstruction using the direct tibial inlay fixation technique from 2009 to 2013, with a mean follow-up of 13.4 months. (6-28 months). The patients were 11males and 3 females with an average age of 29.2 years (17-41 years). Ipsilateral femoral shaft fractures were determined in 2 cases, ipsilateral trochanteric fracture in 1 case and popliteal artery injury in 1 case. Surgery was performed within 2-4 weeks. Spanning-joint external fixation was applied to 2 patients because of gross instability with failure to maintain reduction in a brace. Combined reconstructions involving the posterolateral corner (9/14), anterior cruciate ligament (ACL (11/14)), or medial collateral ligament (MCL (1/14)) were performed. All PCL reconstructions were performed with Achilles allograft. In 1 case with arterial injury, the repair was made by a cardiovascular surgeon. In 2 case, deep infection developed, which was controlled with debridement and antibiotic treatment. Superficial peroneal nerve injury in 1 case was treated with tenolysis in the 6th month, then partial healing was seen at 18 months. In all patients, the preoperative posterior drawer (PD) examination was positive. All patients were evaluated with preoperative and postoperative examination and x-rays. The International Knee Documentation Committee (IKDC) evaluation was applied to all patients at the final follow-up. Results: Postoperative PD examination demonstrated the following: 0 (normal) in 4 patients, 1+ in 7 patients, and 2+ in 3 patients, compared to the preoperative PD of 3+ or greater in all patients. Preoperative IKDC objective evaluation rated all knees as severely abnormal based on instability. The final follow-up objective IKDC evaluation distribution was as follows: A, 4 knees; B, 6 knees; C, 3 knees and D, 1 knee, compared to D in all 14 knees preoperatively. The average final follow-up IKDC subjective score was 74.1 (20-100). Conclusion: Despite transtibial PCL reconstruction being advocated by several authors, it has technical difficulties of the arthroscopic approach to the posterior compartment of the knee. In the open inlay technique, posterior arthrotomy allows accurate placement of the tibial PCL insertion, avoiding the killer curve and more closely duplicating the normal PCL anatomy. Based on our initial experience with this technique at early follow-up, we continue to use the tibial inlay technique as our preferred technique for isolated or combined reconstruction of the PCL.
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Goon, Patrick K. Y., Shirley D. Stougie, Kalpesh R. Vaghela, and J. Henk Coert. "Reconstruction of Distal Radius Osteochondral Defects Using Metatarsal Autografts: a Multi-case Series." Revista Iberoamericana de Cirugía de la Mano 47, no. 01 (May 2019): 003–9. http://dx.doi.org/10.1055/s-0039-1688972.
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Objective Delayed reconstruction of the articular surface of the distal radius after trauma is a difficult problem for hand surgeons, and the common solution is usually partial or total wrist fusion, relieving pain but sacrificing motion. A relative novel reconstructive technique addresses the problem with a free microvascular osteochondral flap, using the 3rd metatarsal (3MT) bone. We investigate the possibility of using the same donor as a graft rather than a free flap. Methods This was a prospective clinical study of patients with isolated lunate facet damage following trauma who underwent surgery to remove the damaged articular surface and in whom the defect was reconstructed with an osteochondral graft from the base of the 3MT. All of the patients were followed-up at specific time intervals, with pre- and postoutcome measures taken, including pain, grip strength, range of motion (ROM), and postoperative radiographs and computed tomography (CT) scans to evaluate graft resorption and union. Only patients with isolated distal radius defects were included. Results The average follow-up period was of 51 months (range: 14–73 months). The results of 7 patients included an average improvement of the pain score in the visual analogue scale (VAS) by 3 points, with an average arc of motion of 135°. In all, there was radiographic evidence of full incorporation of the graft, with no resorption. Donor site morbidity was minimal. Conclusions The current gold standard for distal radius articular surface reconstruction remains a free 3MT osteochondral flap. However, our results using the base of the 3MT as a graft shows promise, and if further follow-up confirms comparable results to the free flap technique, this would mean an easier and equally robust reconstruction without complicated microsurgery. Level of Evidence Therapeutic, Level V case series.
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Goebel, Joel A., and Abraham Jacob. "Use of Mimix hydroxyapatite bone cement for difficult ossicular reconstruction." Otolaryngology–Head and Neck Surgery 132, no. 5 (May 2005): 727–34. http://dx.doi.org/10.1016/j.otohns.2005.01.023.
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OBJECTIVE: To describe the advantages of using MimixTM hydroxyapatite (HA) bone cement in reconstructing a variety of ossicular chain abnormalities. STUDY DESIGN AND SETTING: Case series at a tertiary medical center. RESULTS: Twenty-five cases of HA reconstruction are included in this series (ages 23-74; mean, 47 years). The examples presented include (1) HA as the sole reconstructive material for incus erosion, (2) HA for securing a total or partial ossicular replacement prosthesis, (3) incus augmentation after crimping for revision stapedotomy with incus erosion, (4) HA in primary stapedotomy to fix the crimped prosthesis to an intact incus, and (5) other unique situations. Preoperative and postoperative audiograms were evaluated for 4-tone pure tone average (PTA), speech reception thresholds, word recognition scores, and air-bone gaps (AB gaps). Mean follow-up was 11 months (range 2 to 22 months). The mean PTA improved from 57 dB to 37 dB, whereas the mean AB gaps decreased from 33 dB to 16 dB. There were no cases of infection or extrusion. CONCLUSIONS: Hydroxyapatite bone cement is an excellent adjunct or alternative to ossiculoplasty with preformed prostheses. Easily malleable, rapidly setting, and rapidly hardening, Mimix is particularly well suited for middle ear work. SIGNIFICANCE: Definitive fixation with bone cements during difficult ossicular chain reconstruction may ensure a more enduring successful outcome. (Otolaryngol Head Neck Surg 2005; 132:727-34.)
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Morrell, Nathan T., Deana M. Mercer, and Moheb S. Moneim. "Reconstruction of Chronic Distal Biceps Tendon Rupture using Fascia Lata Autograft." Duke Orthopaedic Journal 2, no. 1 (2012): 55–59. http://dx.doi.org/10.5005/jp-journals-10017-1019.
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ABSTRACT Introduction Distal biceps tendon ruptures are a rare injury and surgical reconstruction is typically recommended for chronic ruptures. There is no consensus regarding the most appropriate reconstruction technique. We present our experience with fascia lata autograft reconstructions of chronic distal biceps tendon ruptures using a modified single incision technique and distal fixation with suture anchors. Materials and methods We retrospectively reviewed the outcome of 12 male patients with chronic distal biceps tendon ruptures who had reconstruction using a fascia lata autograft through a single anterior approach. The age ranged from 29 to 62 years. The average delay to surgery was 26.5 weeks (range 6-68 weeks). A modified single anterior incision was utilized for all patients. Fascia lata autograft was attached distally to the bicipital tuberosity using suture anchors. Tension was set with the elbow in 50° of flexion. The average follow-up was 14.5 months (range 1.5-66 months). All patients were treated by the senior author (MSM). Results Eleven patients (92%) reported subjective improvement in elbow flexion and supination strength, as well as painless range of motion. The average elbow flexion/ extension arc was 126° (5° flexion to 131° flexion) and the average supination/pronation arc was 167 degrees (87° pronation to 80° supination). Five patients underwent isokinetic flexion strength testing which revealed a restoration of 86% of strength when compared to the uninvolved side. Four patients underwent supination isokinetic strength testing which revealed a restoration of 87% of strength when compared to uninvolved side. Four patients reported numbness in the superficial radial nerve distribution that recovered within 12 months. There were no cases of heterotopic ossification or graft rupture. There was one case of wound dehiscence at the elbow that required local flap coverage and went on to heal uneventfully. Aside from a small muscle bulge at the donor site, there were no donor site complications. Conclusion To our knowledge, this is the largest case series of patients undergoing distal biceps tendon reconstruction using fascia lata autograft. Our study has demonstrated a low complication rate with functional results similar to those reported in the literature utilizing a similar technique. We conclude that this technique offers a surgical treatment alternative that yields satisfactory functional outcomes with a low risk of complication. Morrell NT, Mercer DM, Moneim MS. Reconstruction of Chronic Distal Biceps Tendon Rupture using Fascia Lata Autograft. The Duke Orthop J 2012;2(1):55-59.
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Van Tongel, Alexander, Jos Stuyck, Johan Bellemans, and Hilde Vandenneucker. "Septic Arthrt anitis after Arthroscopic Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 35, no. 7 (July 2007): 1059–63. http://dx.doi.org/10.1177/0363546507299443.
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Background Septic arthritis after arthroscopic anterior cruciate ligament reconstruction is a rare complication. In the literature, several different managements are proposed. Hypothesis The graft can be retained during treatment of a septic arthritis after anterior cruciate ligament reconstruction. Study Design Case series; Level of evidence, 4. Methods A retrospective analysis of knee joint infections occurring after arthroscopically assisted anterior cruciate ligament reconstructions was conducted. Fifteen patients were treated for postoperative septic arthritis of the knee after anterior cruciate ligament reconstruction between 1996 and 2005. All patients underwent an urgent extensive arthroscopic debridement (washout and synovectomy) and parenteral antibiotics and oral antibiotics subsequently. Repetitive wash-outs were performed if necessary. The average time at follow-up for our series was 58 months (range, 9-99 months). Results Only 1 graft was removed during debridement because it was nonfunctional. All other patients retained their anterior cruciate ligament reconstruction. There was no reinfection. There were 2 traumatic reruptures. We evaluated 11 patients: in 6 patients the Lachman test showed a translation of more than 3 mm, but all patients had a firm endpoint and there was no subjective instability. Early signs of radiological degeneration were seen in 3 patients. The value for the Lysholm knee scoring scale was 83, on average, ranging from 57 to 100. Regarding the International Knee Documentation Committee score, 2 patients had a final evaluation of normal, 7 patients nearly normal, and 2 patients abnormal. Conclusion The graft can be retained during treatment of septic arthritis after anterior cruciate ligament reconstruction.
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Battaglia, Salvatore, Francesco Ricotta, Salvatore Crimi, Rosalia Mineo, Fabio Michelon, Achille Tarsitano, Claudio Marchetti, and Alberto Bianchi. "Mandibular Reconstruction with Bridging Customized Plate after Ablative Surgery for ONJ: A Multi-Centric Case Series." Applied Sciences 11, no. 22 (November 22, 2021): 11069. http://dx.doi.org/10.3390/app112211069.
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Purpose: Computer-aided methods for mandibular reconstruction have improved both functional and morphological results in patients who underwent segmental mandibular resection. The purpose of this study is to evaluate the overlaying of virtual planning in terms of measures of the Computer Assisted Design/Computer Assisted Manufacturing CAD/CAM plate for mandibular reconstruction in patients who are ineligible for the insertion of reconstructing the titanium plate supported by fibular free flap, due to their poor health status, or in the presence of specific contraindications to autologous bone flap harvest. Materials and methods: The retrospective study performed analyzed the results of nine patients. The patients were treated at the Maxillofacial Surgery Unit of Policlinico S. Orsola of Bologna, Italy, and Policlinico San Marco, Catania, Italy, from April 2016 to June 2021. Superimposition between planning and post operative Computed Tomography CT scan was performed to assess the accuracy. Results: All reconstructive procedures were carried out successfully. No microsurgery-related complications occurred. In two cases, we had plate misplacement, and in one case, plate exposure that led to plate removal. The average accuracy of the series assessed after CT superimposition, as previously described, was 0.95 mm. Conclusions: Considering that microvascular bone transfer is a high-risk procedure in BRONJ patients, we can conclude that the positioning of a customized bridging mandibular prosthesis (CBMP), whether or not it is associated with a microvascular soft tissue transfer, is a safe technique in terms of surgical outcome and feasibility.
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Sever, Celalettin, Fatih Uygur, Yalcin Kulahci, Huseyin Karagoz, and Cihan Sahin. "Thoracodorsal artery perforator fasciocutaneous flap: A versatile alternative for coverage of various soft tissue defects." Indian Journal of Plastic Surgery 45, no. 03 (September 2012): 478–84. http://dx.doi.org/10.4103/0970-0358.105956.
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ABSTRACT Objective: The thoracodorsal artery perforator (TDAP) flap has contributed to the efficient reconstruction of tissue defects that require a large amount of cutaneous tissue. The optimal reconstruction method should provide thin, and well-vascularized tissue with minimal donor-site morbidity. The indications for the use of this particular flap with other flaps are discussed in this article. Materials and Methods: Thirteen patients underwent soft tissue reconstruction using TDAP flaps between 2009 and 2011. Of those, there were four cases of antecubital burn contracture, three cases of axillary burn contracture, two cases of giant hair cell nevus of upper extremity, two cases of axillary reconstruction following severe recurrent hidradenitis, and two cases of crush injury. All patients were male and their ages ranged from 20 to 23 (average, 21 years). The mean follow-up period was 8 months (range, 4-22 months). Results: All reconstructive procedures were completed without any major complications. Minor complications related to transfered flaps were wound dehiscence in one case, transient venous congestion in two cases. Minor complication related to the donor site was seroma in one case. The success rate was 100%, with satisfactory cosmetic results. Conclusions: The TDAP flap is a safe and extremely versatile flap that offers significant advantages in acute and delayed reconstruction. Although the vascular anatomy may be variable, free and pedicled TDAP flap is a versatile alternative for soft tissue defects. It adapts very well to the soft tissue defects with acceptable donor site scar.
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Sohajda, Zoltán, and Levente Juhász. "Az alsó szemhéj pótlása tumoreltávolítás után." Orvosi Hetilap 162, no. 29 (July 18, 2021): 1180–84. http://dx.doi.org/10.1556/650.2021.32146.
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Összefoglaló. Bevezetés: A tumoreltávolítás miatt végzett teljes alsószemhéj-pótlás összetett feladat lehet. A rekonstrukció célja a kielégítő funkcionális és kozmetikai eredmény elérése. Célkitűzés: A módosított Fricke-lebennyel végzett rekonstrukció tapasztalatainak bemutatása az alsó szemhéj teljes hiánya esetén. Módszer: 2010. január és 2020. december között 7 beteg esetében tumoreltávolítás után végeztünk alsószemhéj-rekonstrukciót módosított Fricke-lebennyel. A lebeny képzése a halántéktájon történt. A betegek átlagéletkora 72,8 év volt. A szövettani eredmény minden esetben basocellularis carcinoma volt. Az átlagos követési idő 1,9 év volt. Eredmények: Minden esetben jó funkcionális és esztétikai eredményt értünk el. Lebenynecrosist, sebelégtelenséget nem tapasztaltunk. A korai posztoperatív szakban átmeneti conjunctiva- és szemhéjoedema volt tapasztalható. 3 beteg esetében könnyezés, 1 beteg esetében érintő szőrök okozta szemszúródást észleltünk. Recidíva nem alakult ki a követési idő alatt. Következtetés: Tapasztalataink szerint a módosított Fricke-lebeny kiváló funkcionális és esztétikai eredményt ad a tumoreltávolítás utáni teljes alsószemhéj-rekonstrukcióban. Orv Hetil. 2021; 162(29): 1180–1184. Summary. Introduction: The full-thickness lower eyelid reconstruction after tumor removal can be a complex challenge. The aim of reconstruction is to reach an appropriate functional and cosmetic result. Objective: To present the retrospective analysis of the reconstruction’s experience with the use of Fricke’s flap in the case of full-thickness lower eyelid defect. Method: Between January 2010 and December 2020, in the case of 7 patient’s after tumor excision on lower eyelid, reconstruction was performed with a modified Fricke’s flap. The Fricke’s flap was fashioned in the temple region. The patients’ average age was 72.8 years. The histological result was basocellular carcinoma in every case. The average follow-up period was 1.9 years. Results: In all cases, good functional and cosmetic result was detected. There were not any flap necrosis and wound dehiscence. In the early postoperative period, temporary edema of the eyelid and conjunctiva was detected. Epiphora occurred in the case of 3 patients and we observed eye irritation caused by skin hair in the case of 1 patient. Tumor recurrence was not detected during the follow-up period. Conclusion: In our experience, the modified Fricke’s flap has excellent functional and aesthetic results in the reconstruction after tumor removal on the lower eyelid. Orv Hetil. 2021; 162(29): 1180–1184.
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Maestro, Antonio, Iván Pipa, Nicolás Rodríguez, Carmen Toyos, Marcelino Torrontegui-Duarte, and Cesar Castaño. "Safety and Performance of Titanium Suture Anchors Used in Knee Ligament Repair Procedures." Medicina 57, no. 3 (March 19, 2021): 287. http://dx.doi.org/10.3390/medicina57030287.
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Injuries to the knee ligaments can be particularly disabling in young patients, given the risk of long-term disability if adequate fixation is not achieved during initial repair. The TWINFIX™ titanium (Ti) suture anchor with ULTRABRAID™ Suture (Smith and Nephew, London, UK) was designed to secure tendon and ligament reconstructions with increased boney ingrowth at the anchor site with minimal invasive technique. This retrospective analysis looked at 33 patients (41 implants) operated with this device between 2015 and 2019 at a single institution. The average age of patients was 33.18 years (standard deviation [SD], 15.26), with an average body mass index of 24.88 (SD, 3.49). The indications were lateral extra-articular tenodesis during anterior cruciate ligament reconstruction, medial patellofemoral ligament reconstruction, quadriceps or patellar tendon repair and medial collateral ligament repair. After an average follow up of 24.3 + 6.53 months, there was no reports of clinical failure or radiographic evidence of implant failure or loosening. One patient experienced a complication unrelated to the study device, requiring manipulation under anesthesia with resolution of symptoms. This case series supports the safety and performance of this implants for the knee procedures in which its use is indicated. Additional follow-up will be required to determine whether these effects are sustained at medium- and long-term durations.
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Godoy dos Santos, Alexandre Leme, Marcos Hideyo Sakaki, Rodrigo Sousa Macedo, Rafael Barban Sposeto, Rafael Trevizan, and Tulio Diniz Fernandes. "PO 18101 - Talar body reconstruction for nonunions and malunions." Scientific Journal of the Foot & Ankle 13, Supl 1 (November 11, 2019): 12S. http://dx.doi.org/10.30795/scijfootankle.2019.v13.1013.
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Introduction: Talar body and neck nonunions and malunions may undergo reconstructive surgery when joint cartilage is still viable and no talar collapse or infection has occurred. This is a rare condition, and studies supporting the procedure have a small number of cases. Objective: To report a case series of six patients who underwent talar reconstructions. Methods: Six patients with talar malunions or nonunions who underwent surgical treatment were reviewed in this retrospective study. There were three nonunions and two malunions of the talar body and one malunion of the talar neck. Clinical evaluation included all the parameters used in the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale. Arthritic degeneration of the ankle joint was assessed according to a modified Bargon scale. Results: The mean follow-up was 86 months (range 24-282 months). There were no cases of postoperative avascular necrosis of the talus. Four of the six patients in our series required a subtalar fusion as part of the reconstructive procedure. The average preoperative AOFAS hindfoot score was 34; at the time of the last evaluation, it was 74. The mean preoperative score on the modified Bargon scale for the tibiotalar joint was 1.17. At the last follow-up, it rose to 1.33. Three different deformities of the talus were identified: (a) flattening of the talus; (b) extra-articular step; (c) intraarticular step. Conclusion: Reconstruction of talar nonunions and malunions improved function in selected patients with a low risk of complications. Three different anatomical patterns of talar nonunions and malunions were identified.
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Tingley, Martin, Peter F. Craigmile, Murali Haran, Bo Li, Elizabeth Mannshardt, and Bala Rajaratnam. "On Discriminating between GCM Forcing Configurations Using Bayesian Reconstructions of Late-Holocene Temperatures*." Journal of Climate 28, no. 20 (October 13, 2015): 8264–81. http://dx.doi.org/10.1175/jcli-d-15-0208.1.
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AbstractSeveral climate modeling groups have recently generated ensembles of last-millennium climate simulations under different forcing scenarios. These experiments represent an ideal opportunity to establish the baseline feasibility of using proxy-based reconstructions of late-Holocene climate as out-of-calibration tests of the fidelity of the general circulation models used to project future climate. This paper develops a formal statistical model for assessing the agreement between members of an ensemble of climate simulations and the ensemble of possible climate histories produced from a hierarchical Bayesian climate reconstruction. As the internal variabilities of the simulated and reconstructed climate are decoupled from one another, the comparison is between the two latent, or unobserved, forced responses. Comparisons of the spatial average of a 600-yr high northern latitude temperature reconstruction to suites of last-millennium climate simulations from the GISS-E2 and CSIRO models, respectively, suggest that the proxy-based reconstructions are able to discriminate only between the crudest features of the simulations within each ensemble. Although one of the three volcanic forcing scenarios used in the GISS-E2 ensemble results in superior agreement with the reconstruction, no meaningful distinctions can be made between simulations performed with different estimates of solar forcing or land cover changes. In the case of the CSIRO model, sequentially adding orbital, greenhouse gas, solar, and volcanic forcings to the simulations generally improves overall consensus with the reconstruction, though the distinctions are not individually significant.
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Ooi, Adrian, Jonathan Ng, Christopher Chui, Terence Goh, and Bien Keem Tan. "Maximizing Outcomes While Minimizing Morbidity: An Illustrated Case Review of Elbow Soft Tissue Reconstruction." Plastic Surgery International 2016 (May 29, 2016): 1–8. http://dx.doi.org/10.1155/2016/2841816.
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Background. Injuries to the elbow have led to consequences varying from significant limitation in function to loss of the entire upper limb. Soft tissue reconstruction with durable and pliable coverage balanced with the ability to mobilize the joint early to optimize rehabilitation outcomes is paramount. Methods. Methods of flap reconstruction have evolved from local and pedicled flaps to perforator-based flaps and free tissue transfer. Here we performed a review of 20 patients who have undergone flap reconstruction of the elbow at our institution. Discussion. 20 consecutive patients were identified and included in this study. Flap types include local (n=5), regional pedicled (n=7), and free (n=8) flaps. The average size of defect was 138 cm2 (range 36–420 cm2). There were no flap failures in our series, and, at follow-up, the average range of movement of elbow flexion was 100°. Results. While the pedicled latissimus dorsi flap is the workhorse for elbow soft tissue coverage, advancements in microvascular knowledge and surgery have brought about great benefit, with the use of perforator flaps and free tissue transfer for wound coverage. Conclusion. We present here our case series on elbow reconstruction and an abbreviated algorithm on flap choice, highlighting our decision making process in the selection of safe flap choice for soft tissue elbow reconstruction.
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Tardivo, Gianmarco, and Antonio Berti. "A Dynamic Method for Gap Filling in Daily Temperature Datasets." Journal of Applied Meteorology and Climatology 51, no. 6 (June 2012): 1079–86. http://dx.doi.org/10.1175/jamc-d-11-0117.1.
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AbstractA regression-based approach for temperature data reconstruction has been used to fill the gaps in the series of automatic temperature records obtained from the meteorological network of Veneto Region (northeastern Italy). The method presented is characterized by a dynamic selection of the reconstructing stations and of the coupling period that can precede or follow the missing data. Each gap is considered as a specific case, identifying the best set of stations and the period that minimizes the estimated reconstruction error for the gap, thus permitting a potentially better adaptation to time-dependent factors affecting the relationships between stations. The best sampling size is determined through an inference procedure, permitting a highly specific selection of the parameters used to fill each gap in the time series. With a proper selection of the parameters, the average errors of reconstruction are close to 0 and those corresponding to the 95th percentile are typically around 0.1°C. In comparison with similar regression-based approaches, the errors are lower, particularly for minimum temperatures, and the method limits inversions between the minimum, mean, and maximum temperatures.
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Webster, Theresa K., Sthefano Araya, Joseph Bartolacci, Grace M. Amadio, Juliet C. Panichella, Joseph Costa, and Sameer A. Patel. "Should Sickle Cell Trait Be a Contraindication to Breast Reconstruction?—A Case Series Analysis." Journal of Reconstructive Microsurgery Open 08, no. 01 (January 2023): e51-e53. http://dx.doi.org/10.1055/s-0043-1769752.
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Abstract Background While sickle cell disease has long been considered a contraindication to breast free flap reconstruction, there have been less definitive decisions about the impact of sickle cell trait on these procedures. We sought to analyze the patients with sickle cell trait who underwent free deep inferior epigastric perforator (DIEP) flap and pedicled latissimus dorsi (LD) flap at a single institution to determine the reconstructive outcomes. Methods Patients with sickle cell trait who underwent breast free DIEP and pedicled LD reconstruction from 2007 to 2021 at a single institution by the lead surgeon were analyzed for demographics and surgical outcomes. Results Four patients were identified as having sickle cell trait and having undergone a breast flap reconstruction. The average age of the patients was 54 years, median body mass index was 25, and past medical history was notable for one patient being a current smoker, and one patient having hypertension. Two patients received a unilateral free DIEP flap, one received a bilateral free DIEP flap, and one received a unilateral pedicled LD flap for a total of five flaps in four patients. Three of the patients received prior hormone therapy, one received prior radiation therapy, and one received prior chemotherapy. There were no instances of flap failure, vessel thrombosis, pulmonary embolism, or deep venous thrombosis. One patient experienced wound dehiscence. Conclusion In this case series we present four patients with sickle cell trait who successfully underwent breast flap reconstruction without any instances of flap or systemic thrombosis. More work is needed to determine how to pre- and postoperatively optimize patients with sickle cell trait for favorable breast flap reconstruction outcomes.
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Marchesini, Andrea, Letizia Senesi, Francesco De Francesco, Pier Paolo Pangrazi, Andrea Campodonico, Rocco Politano, and Michele Riccio. "Efficacy of the Arteriovenous Loop for Free Flap Reconstruction in Patients with Complex Limb Trauma: Case Series and Literature Review." Medicina 56, no. 11 (November 23, 2020): 632. http://dx.doi.org/10.3390/medicina56110632.
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Background and objectives: Complex limb traumas are commonly treated with microsurgical reconstruction and free flaps. However, complications are frequent in patients affected by a previous trauma or comorbidity, atheromasia and a single valid vessel. Free flap reconstruction is indeed a challenging procedure in complex injuries, which may increase the risk of limb ischemia. The Arteriovenous loop (AVL) technique may be considered an efficient alternative treatment. We herein report our procedure and previous research regarding the AVL method using a two-step reconstruction in cases of complex high-energy limb injuries. Materials and Methods: In this single center retrospective cohort study, all the patients from 2014 to 2018 who underwent to AVL reconstruction were assessed. A total of six patients were included in the study for traumatic limb trauma. The two-stage technique was performed each time. The age and sex of patient, the time between stage one and two, the length of AVL loop and rate of free flap success were evaluated. Results: A total of seven AVL reconstructions were performed. The mean age of patients was 36 years old. Eight free flaps were performed; six free flaps were transferred to the vascular loops. The average time between stage one and two was 13 days. The mean length of the pedicle was 25 cm for the upper limb and 33.7 cm for the lower limb. All the free flaps successfully take root. In one case, a surgical revision was required the second day post-operatory due to venous congestion. Conclusions: AVL is a useful and safe technique in microsurgical reconstruction which will prevent vascular complications. Our investigations suggest the efficacy and feasibility of a two-step intervention in acute post-traumatic events. A single-step procedure should be preferred in chronic situation and oncologic reconstruction.
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Kömürcü, Mahmut, Mustafa Kürklü, Bahtiyar Demiralp, Ali Sabri Atesalp, Serap Alsancak, and Mustafa Basbozkurt. "First ray reconstruction with distraction osteogenesis." Prosthetics and Orthotics International 32, no. 1 (January 1, 2008): 50–56. http://dx.doi.org/10.1080/03093640701610409.
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Disarticulation of the thumb at the metacarpophalangeal joint level is not beneficial either aesthetically or functionally without additional surgery because it requires a bulky and an unacceptable prosthesis to be made for this amputation level. In this study, the authors have presented our experience of 12 metacarpal distractions in thumb amputated patients. Twelve male patients who had thumb amputation due to gunshot wounds were included in the study. Before the operation, aesthetic hand prostheses were made for 5 of the12 patients. Callus distraction was performed with the use of a mini Ilizarov type external fixator in 7 cases and uniplanar dynamic mini external fixator in 5 cases too. External fixators were removed after the completion of the radiographic consolidation. Five patients whose prosthesis had been made before the operation wore their prosthesis for an average 6.8 months (5 – 14) due to poor appearance and poor construction. Union of the lengthened segment was observed in all cases. Average lengthening was 28.9 mm (range from 25 – 37). Average healing time was 2.1 months (range from 1.8 – 2.5). Average healing index was 0.73 month/cm (range from 0.65 – 0.88). Pin tract infection was seen in 7 cases (58.3%). Volar angulation developed after removing the external fixator in 1 case. Webplasty was performed in all cases. Patients were evaluated by means of Disability of the Arm, Shoulder and Hand (DASH) score and pick-up test. It was concluded that the metacarpus lengthening by callus distraction technique may be a functionally and cosmetically effective reconstruction method for traumatic thumb amputations. It is believed that the possibility for a functionally and aesthetically acceptable fabrication of a thumb prosthesis, by providing a suction suspension with distraction and/or webplasty procedures.
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Ivanov, S. A. "NEW SOLUTIONS IN NASAL ALA RECONSTRUCTION." Health and Ecology Issues, no. 1 (March 28, 2018): 36–42. http://dx.doi.org/10.51523/2708-6011.2018-15-1-6.
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The article describes the technique and results of the method of single-stage nasal ala reconstruction based on a modified puzzle-flap. The developed method has been applied for nasal ala reconstruction in 10 patients after malignant tumor excision. The anatomical and functional outcomes of the reconstruction were evaluated with the use of NAFEQ questioning and visual analogue scale. The external skin, internal nasal lining, and cartilage support of nasal ala were restored in a single-stage procedure in all the cases. The natural appearance and contour of neoala were achieved with a minimal correction in the donor area. Partial necrosis of a flap was observed in one case. The anatomical outcome of the reconstruction was evaluated as completely satisfactory or satisfactory in 9 out of 10 patients (90%) according to NAFEQ. The average evaluation of the results of the reconstruction by the VAS scale was 81.0 ± 6.8 (100-point scale), the minimal value - 70 points, the maximal one - 95 points. Nasal function was not disturbed in any case. The proposed method of nasal ala reconstruction allows to achieve acceptable functional and anatomical results in a single-stage procedure.
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Jaramillo, Germán A., Diego F. Luna, Narly V. Gómez, and Rubén D. Arias. "Reconstruction of medial patellofemoral ligament arthroscopically assisted: a prospective case series with short-term clinical follow-up." Orthopaedic Journal of Sports Medicine 6, no. 12_suppl5 (December 1, 2018): 2325967118S0019. http://dx.doi.org/10.1177/2325967118s00198.
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The medial patellofemoral ligament (MPFL) is one of the most important anatomical structure that stabilize the patella, during its injury a repetitive dislocation occurs. The reconstruction of this ligament, it seeks to avoid the recurrence of these episodes, for which there are various surgical techniques, one of these the arthroscopy, it can reduce adverse events of the procedure. The aim of this study is to describe the clinical follow-up of patients who had a reconstruction of the MPFL arthroscopically assisted. This is a prospective case series carried out in two hospitals of Medellín city, between 2010 and 2016. For the clinical follow-up, Lysholm, Kujala and Tegner knee scores were performed before and 12 months after the surgical procedure. Were applied Shapiro Wilk tests to evaluate normality and T-student to compare the results of the scores. We follow fifteen patients, 16 reconstructions of MPFL, of these 12 were female. The average time between the first dislocation and surgery was 12 months. Statistically significant differences were found when comparing the three scores before and after surgery (p= <0.05). Most patients improved pain and no patient required reoperation in the follow-up period. The reconstruction of MPFL arthroscopically assisted is a minimal access method that allows identifying the anatomical insertions of the MPFL, and is a safe technique that causes low morbidity and satisfactory clinical evolution of the patients.
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Sini, Daniel, Andres M. Jalil, Cristian A. Ferreyra, Mauricio Balla, Pablo S. Mancini, and Gino Borsani. "Minimally Invasive Technique for the Reconstruction of the Medial Posteral Corner of the Knee associated to Anterior Cruciate Ligament. Functional Outcomes. Case Series." Orthopaedic Journal of Sports Medicine 6, no. 12_suppl5 (December 1, 2018): 2325967118S0018. http://dx.doi.org/10.1177/2325967118s00181.
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The medial collateral ligament (MCL) and the anterior cruciate ligament (ACL) are the most commonly damaged ligaments of the knee. These are common injuries in young people and athletes. Joint laxity may contribute to long-term cartilage degeneration in the medial compartment and give functional limitations as a result of severe lesions of ACL and MCL treated conservatively. In severe acute injuries and chronic symptomatic instabilities should be indicated surgical treatment. The anatomical technique of medial reconstruction of the knee returns stability and allows a distribution of the normal load in patients with severe or chronic acute injuries. Anatomical reconstructions require large incisions and dissections of soft tissues, favoring the risk of contracture in flexion or extension. The technique we used in our series consists of a modification of Laprade’s anatomical technique through a non-anatomical triangular medial reconstruction of the knee, using a minimally invasive approach. Objectives: Show our technique in combined injuries of medial collateral ligament and ACL. Methods: Observational study, case series, retrospective. Population of five patients (N: 5) adults of both sexes, older than 18 years, with a diagnosis of combined lesion of MCL grade II - III with clinical and subjective instability and complete rupture of ACL that have been treated surgically with an anatomical reconstruction using arthroscopic approach of the ACL and a triangular reconstruction with the modified anatomical technique of LaPrade through a minimally invasive approach by the Orthopedics and Traumatology Service of the Reina Fabiola University Clinic. A descriptive statistical analysis of the data was performed. Results: A total of five patients with an average age of 27 ± 10.89 years were included. Of the total 4 (80%) correspond to the male sex. 100% of the cases presented a grade III lesion of the MCL. Patients were followed for an average of 16 ± 9.28 months. The ROM achieved by the patients was of full extension (0°) in 100% of them and flexion in average of 130° ± 14,14. All the cases presented exceeded 100° of flexion. Pain (EVA) 0.45 / 10. The maneuvers of the internal yawn and Lachman were negative in the whole series. According to Lysholm’s functional score, there was an improvement on average of 50.40 ± 6.23 points between the preoperative evaluation, which was initially poor (40.40 ± 9.91) and the post-operative excellent (90.80 ± 4.97). All the cases in the series presented a response to treatment greater than 84 points according to the Lysholm score, with an average good to excellent result in the total. Conclusion: Although there are anatomical techniques validated for the reconstruction of the MCL, the vast majority of them involves an extensive approach with the consequent damage of soft tissues derived from it. The current trend consists of a less aggressive treatment of LCM with an associated reconstruction of the ACL. The fact of performing an anatomical reconstruction with good initial and stable fixation, minimizing soft tissue damage, aims at early rehabilitation, decreasing the chances of rigidity. We did not observe any significant limitation in the ROM, nor post-surgical rigidity in our series of patients. All of them presented a good to excellent Lysholm score and no complications were observed. This type of construct is less invasive and more practical to perform, since it uses a fixation device less than the anatomical technique of LaPrade, which reduces the cost of surgery and decreases less the bone stock, on the other hand the surgical time is not prolonged. Other advantages are that it consists of a short construct with low risk of voltage loss, with a favorable isometry and that is fast, easy to perform and reproducible.
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Suchyta, Marissa, Christopher Hunt, Waleed Gibreel, Diya Sabbagh, Kryzysztof Gorny, and Samir Mardini. "4360 Black Bone MRI from the Lab to Clinical Practice: Eliminating Radiation Exposure in Reconstructive Surgery Patients." Journal of Clinical and Translational Science 4, s1 (June 2020): 105–6. http://dx.doi.org/10.1017/cts.2020.325.
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OBJECTIVES/GOALS: Virtual surgical planning and 3D printing enable streamlined surgeries and increased complexity. These technologies, however, require CT scans and radiation exposure. This project’s goal is to optimize and demonstrate the accuracy of Black Bone MRI for surgical planning in reconstructive surgery. METHODS/STUDY POPULATION: Four common craniofacial surgeries were planned and performed on cadaver specimens (maxillary advancement, orbital floor reconstruction with patient-specific implants, cranial vault reconstruction, and fibular free flap reconstruction of the mandible). For each surgical procedure, ten cadaver heads were used. Five of each surgery were planned and 3D printed guides were created utilizing Black Bone MRI versus five with CT scans. Following mock surgeries, all specimens underwent a post-operative CT scan. 3d reconstruction was performed and surgical accuracy compared to the plan was assessed using GeoMagic Wrap, assessing average post-operative deviation from plan. RESULTS/ANTICIPATED RESULTS: In all surgeries, guides created from Black Bone MRI demonstrated high accuracy to surgical plan. Average osteotomy (cut) deviation from plan was not statistically significantly different when Black Bone MRI was used compared to CT scans for planning and guide creation in the wide variety of craniofacial surgeries performed. The average deviation of post-operative anatomy from pre-operative plan was also not statistically significant when Black Bone MRI versus CT scans were utilized in the surgeries. These results then enabled the translational application of this technology clinically, and we demonstrate a clinical reconstructive craniofacial case planned utilizing Black Bone MRI. DISCUSSION/SIGNIFICANCE OF IMPACT: This study demonstrates that virtual surgical planning and 3d surgical guide creation can be performed using Black Bone MRI with comparable accuracy to CT scans in a wide variety of craniofacial procedures. This could dramatically reduce radiation exposure for patients. The successful segmentation, virtual planning, and 3d printing of accurate guides from Black Bone MRI demonstrate potential to change the pre-operative planning standard of care. This project, overall, also demonstrates the development of new solutions to advance clinical care, thus serving as an example of moving translational science from a concept to the operating room.
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Rugg, Caitlin M., Austin A. Pitcher, Christina Allen, and Nirav K. Pandya. "Revision ACL Reconstruction in Adolescent Patients." Orthopaedic Journal of Sports Medicine 8, no. 9 (September 1, 2020): 232596712095333. http://dx.doi.org/10.1177/2325967120953337.
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Background: High failure rates have been documented after anterior cruciate ligament reconstruction (ACLR) in pediatric patients, and revision surgery is indicated due to high activity levels of children and adolescents. Purpose: To define trends in revision ACLR in patients who underwent initial ACLR at younger than 18 years. Study Design: Case series; Level of evidence, 4. Methods: An electronic medical record was used to retrospectively identify revision ACLR procedures performed by 2 surgeons between the years 2010 and 2016 in patients younger than 18 years at initial reconstruction. Descriptive information, intraoperative findings, surgical techniques, and rehabilitation data were recorded from initial and revision surgeries. Descriptive statistics were used. Results: A total of 32 patients (17 girls, 15 boys) met the inclusion criteria, with a mean age of 15.8 years at initial reconstruction. For initial reconstructions, 15 patients underwent transphyseal procedures, 3 patients underwent adult-type procedures using an anatomic reconstruction technique that did not take into account the physis, and 2 patients underwent partial intraepiphyseal procedures. Graft types included hamstring autograft (n = 17), allograft (n = 5), hybrid (n = 4), and bone–patellar tendon–bone autograft (BTB; n = 3). Average primary reconstruction graft diameter was 8.0 mm (girls, 7.72 mm; boys, 8.36 mm; P = .045). After initial reconstruction, 10 patients had postoperative protocol noncompliance, and 8 patients reported delayed recovery. Mean time to retear was 565 days (range, 25-1539 days). At revision, BTB autograft was used in 50% (n = 16), followed by hamstring autograph (31.3%; n = 10) and allograft (12.5%; n = 4); mean graft diameter was 9.05 mm. Chondral surgery was more common during revision (25% for revision vs 0% for index; P = .031). There were 4 patients who required staged reconstruction with bone grafting. At mean final follow-up of 29.5 months (SD, 22.2 months), there were 3 graft failures (9.4%) and 5 contralateral ACL ruptures (15.6%). Conclusion: Most patients with ACL graft failure were adequately treated with a single revision. Conversion from a soft tissue graft to a BTB autograft was the most common procedure. Infrequently, patients required staged reconstructions. Providers should have a high index of suspicion for associated intra-articular injuries resulting from graft failure in adolescent patients.
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Deldar, Romina, Adaah A. Sayyed, Parhom Towfighi, Nathan Aminpour, Olutayo Sogunro, Jennifer D. Son, Kenneth L. Fan, and David H. Song. "Postmastectomy Reconstruction in Male Breast Cancer." Breast Journal 2022 (March 29, 2022): 1–7. http://dx.doi.org/10.1155/2022/5482261.
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Introduction. Less than 1% of all breast cancers are diagnosed in males. In females, postmastectomy breast reconstruction is associated with increased patient satisfaction. However, there is a paucity of literature describing reconstructive options for postmastectomy deformity in the male chest. The purpose of this systematic review was to evaluate postmastectomy reconstruction outcomes in males with breast cancer. Methods. A systematic review was performed in accordance with PRISMA guidelines. Ovid MEDLINE, Embase, Cochrane, and Web of Science were queried for records pertaining to the study question using medical subject heading (MeSH) terms such as “male breast cancer,” “mastectomy,” and “reconstruction.” No limitations were placed on the year of publication, country of origin, or study size. Study characteristics and patient demographics were collected. Primary outcomes of interest included postoperative complications, recurrence rate, and mortality rate. Results. A total of 11 articles examining 29 male patients with breast cancer who underwent postmastectomy reconstruction were included for analysis. Literature was most commonly available in the form of case reports. The average age was 59.6 +/−11.4 years. Reconstruction methods included fat grafting (n = 1, 3.4%), silicone implants (n = 1, 3.4%), and autologous chest wall reconstruction with local flaps (n = 26, 89.7%). Postoperative complications occurred in two patients (6.8%), including partial nipple necrosis (n = 1) and hypertrophic scarring (n = 1). Of the studies reporting patient satisfaction, all patients were pleased with the aesthetic appearance of their chest. Conclusion. This systematic review revealed the limited availability of research regarding postmastectomy chest reconstruction in males with breast cancer. Nevertheless, the evidence available suggests that reconstruction can restore a patient’s body image and, thus, should be regularly considered and discussed with male patients. Larger studies are warranted to further shed light on this population.
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Tracy, Jeremiah C., Bryan Brandon, and Samip N. Patel. "Scapular Tip Free Flap in Composite Head and Neck Reconstruction." Otolaryngology–Head and Neck Surgery 160, no. 1 (August 7, 2018): 57–62. http://dx.doi.org/10.1177/0194599818791783.
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Objectives To describe the use of the scapular tip free flap (STFF) in the reconstruction of head and neck defects. Study Design Case series with chart review. Setting Academic medical center. Subjects and Methods A review of the electronic medical record was performed of all patients who underwent head and neck reconstructive surgery with STFFs from January 1, 2014, through January 1, 2016. Details regarding the disease, defect reconstructed, and surgical outcomes were quantified. Results Thirty-one consecutive cases were performed at our institution within the period reviewed. The procedures included reconstruction of 5 maxillectomy and 26 mandibulectomy defects. The mean length of mandible reconstructed was 6.8 cm (95% CI, 6.01-7.59; range, 4.0-10.2). Osteotomies were made to contour the scapular bone in 11 cases, including double osteotomies performed in 2 cases. The most common surgical complications were orocutaneous fistula and postoperative hematoma, which occurred in 3 (10%) and 2 (6.5%) of 31 patients, respectively. Conclusion This series describes a large number of STFFs performed in head and neck reconstruction. The average length of bony defect repair can be significantly larger than what was previously described. Performing osteotomies to the STFF allows for application to anterior mandibular defects. The STFF offers a large soft tissue component, a relatively long pedicle, and acceptable donor site morbidity. The STFF is a versatile reconstructive option that should be considered to address composite defects of the head and neck.
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Iyengar, Karthikeyan, William Loh, and Hosam Matar. "Modified Eaton-Littler's Reconstruction for Traumatic Thumb Carpometacarpal Joint Instability: Operative Technique and Clinical Outcomes." Journal of Wrist Surgery 07, no. 03 (November 9, 2017): 191–98. http://dx.doi.org/10.1055/s-0037-1607423.
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Background Injuries to thumb carpometacarpal joint ligaments lead to instability. Eaton-Littler's ligament reconstruction traditionally uses a strip of flexor carpi radialis to stabilize the CMC joint. Study Description We have modified this technique to reproduce the direction of active action of the anterior oblique ligament by reconstructing both the volar and dorsoradial ligaments. In this prospective study, we evaluated patients with confirmed traumatic thumb CMC joint instability who underwent modified Eaton-Littler's reconstruction. Strength analysis, Michigan Hand Outcome Questionnaire, QuickDASH, and subjective outcome measures were collected pre- and postoperatively with minimum 3 years of follow-up. Eleven patients were included in the final analysis, with mean age of 29 years (range: 16–52) and average follow-up of 6.2 years (range: 3–11). There was a statistically significant improvement in all outcome measures. Clinical Relevance Our modified technique helps to simultaneously address both volar and dorsal ligaments and yields satisfactory clinical outcomes at medium term follow-up. Level of Evidence Level IV, case series.
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Evans, Abigail A., Virginia F. Straker, and Richard M. Rainsbury. "Breast Reconstruction at a District General Hospital." Journal of the Royal Society of Medicine 86, no. 11 (November 1993): 630–33. http://dx.doi.org/10.1177/014107689308601106.
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Breast reconstruction is normally carried out by plastic surgeons, but the advent of permanent tissue expanders places post-mastectomy reconstruction within easy reach of the general surgeon. Nineteen patients underwent breast reconstruction between 1989 and 1991 using a subpectoral silicone-based, double lumen tissue expander. Assessment of results was by: ( a) patient completed questionnaire; and ( b) third party evaluation of standardized photographs. The mean operating time was 58 min (40–80 min) and mean hospital stay 3 days (2–7 days). Complications included one flap necrosis and one leaking injection port. Outpatient tissue expansion required an average of seven visits (4–11) and was completed in an average of 12 months (7–19). The injection port was subsequently removed under local anaesthetic as a day case. The fully dressed appearance following reconstruction was graded good or excellent by 100% of patients and in over 80% of third-party assessments. Equivalent figures for the appearance when wearing a bra were 93% and 60% and undressed 57% and 47%, respectively. All patients recommended the procedure but 25% found inflation uncomfortable. Subpectoral tissue expansion is a safe, cosmetically acceptable method of breast reconstruction which is associated with a high level of patient satisfaction.
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Frings, Jannik, Tobias C. Drenck, Ralph Akoto, Arno Schmeling, and Karl-Heinz Frosch. "Clinical results after distal femoral osteotomies in patients with patellar maltracking." Orthopaedic Journal of Sports Medicine 5, no. 4_suppl4 (April 1, 2017): 2325967117S0014. http://dx.doi.org/10.1177/2325967117s00143.
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Aims and Objectives: Few clinical trials analyze the results after distal femoral osteotomies (torsional and axial adjustment) for patellar maltracking with or without patellar instability. The purpose of the presented study is to capture the clinical results as well as the reluxation rate after torsional osteotomy or axial adjustment (Types 3d, 3e and 5 according to Frosch et al.). Materials and Methods: Between 2010 and 2015 294 cases of patellar instability and/or maltracking were treated in our hospital, 277 surgically. All patients were classified according to Frosch et al. and treated by the corresponding algorithm. 49 patients received a distal femoral osteotomy. Torsional angle and leg axis were radiologically measured in all patients. We used the common scoring systems and determined the redislocation rate. Results: Type 3e and 5 27 cases (18 patients, average 22y) torsional osteotomies were performed. 21 of 27 cases were classified as type 3e (7%), 6 as type 5 (2%). 22 other cases (19 patients) with an average age of 27 years (14-46 years) were classified as type 3d (7,5% of all cases). 17 axial adjustments were performed, 4 isolated MPFL reconstructions and 1 osteotomy of the tibial tubercle. Average femoral antetorsion was 38,6° (±9,3°), die tibial torsion was 35,1° (±11,7°). The average deviation of the leg axis in the frontal plane was 5° (±2,4°) varus (n=9) and 2,8° (±2,9°) valgus (n=14). The mean TT-TG distance was 19,9 mm (±4,9 mm). Torsional osteotomy was combined with MPFL-reconstruction (n=19), tibial tubercle transfer (Ø12,6 mm, n=13) or axial correction (Ø4° varus, Ø6° valgus, n=13), 5 double osteotomies. Torsion was corrected by 13° femoral and 11° tibial on average. After 19 months VAS was 1.2, Kujala 78.8, a Lysholm 79.1, Tegner 4. Only one patient experienced a subluxation after a fall. No redislocation. 3d 7,5% (n=22) showed a mean axial deviation of 6,5° (±2,2°) valgus. Average TT-TG distance was 18,3 mm (±5,8 mm). We performed 15 closed-wedge varus distal femoral osteotomies (Ø6,8°±2,3°), combined with an Elmslie-Trillat (n=14) or Fulkerson procedure (n=1), MPFL reconstruction (n=15) or lateral release (n=1). 4 isolated MPFL reconstructions. One case of a pathological lateral slope with patellar instability was treated by double osteotomy (8° femoral to varus, 4° tibial to valgus). One tibial varisation (5,5°) with MPFL reconstruction and Elmslie-Trillat procedure. Tibial tubercle was medialized by 11 mm ±6,7 mm on average. 22 MPFL reconstructions were done. After average 33 months VAS was 2.3, Kujala 72, Lysholm 79, Tegner 4. No redislocation. Conclusion: Torsional and axis correcting osteotomies are suitable techniques to treat patellar instability or maltracking. Clinically the patients’ benefit is substantial. Consideration of additional procedures is crucial to success, a thorough analysis of all causal pathologies is mandatory. The results approve our individual therapy algorithm in the treatment of patellar instability and maltracking caused by torsional deformities or axis deviations.
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Fahrudin, Arfan Eko, Endarko Endarko, Khusnul Ain, and Agus Rubiyanto. "Enhanced image reconstruction of electrical impedance tomography using simultaneous algebraic reconstruction technique and K-means clustering." International Journal of Electrical and Computer Engineering (IJECE) 13, no. 4 (August 1, 2023): 3987. http://dx.doi.org/10.11591/ijece.v13i4.pp3987-3997.
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<span lang="EN-US">Electrical impedance tomography (EIT), as a non-ionizing tomography method, has been widely used in various fields of application, such as engineering and medical fields. This study applies an iterative process to reconstruct EIT images using the simultaneous algebraic reconstruction technique (SART) algorithm combined with K-means clustering. The reconstruction started with defining the finite element method (FEM) model and filtering the measurement data with a Butterworth low-pass filter. The next step is solving the inverse problem in the EIT case with the SART algorithm. The results of the SART algorithm approach were classified using the K-means clustering and thresholding. The reconstruction results were evaluated with the peak signal noise ratio (PSNR), structural similarity indices (SSIM), and normalized root mean square error (NRMSE). They were compared with the one-step gauss-newton (GN) and total variation regularization based on iteratively reweighted least-squares (TV-IRLS) methods. The evaluation shows that the average PSNR and SSIM of the proposed reconstruction method are the highest of the other methods, each being 24.24 and 0.94; meanwhile, the average NRMSE value is the lowest, which is 0.04. The performance evaluation also shows that the proposed method is faster than the other methods.</span>
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Adil, Dehhaze, Echmili Mouad, Tazi Hanae, Tita Sara, Taybi Otmane, Diher Issam, Daghouri Nada-Imane, and Laabaci Rim. "Orbital Exenteration: Indications and Reconstruction Methods." SAS Journal of Surgery 8, no. 08 (August 5, 2022): 516–22. http://dx.doi.org/10.36347/sasjs.2022.v08i08.005.
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Orbital exenteration is a disfiguring surgery; its major indication is the treatment of extensive orbito-palpebral malignancies. The reconstruction of the residual cavity is a real challenge despite the different reconstruction techniques, especially on weakened terrain. The purpose of this study was to assess and compare the clinical indications and reconstructive methods and outcomes with previously reported data. A retrospective study was conducted on five patients who underwent orbital exenteration surgery. Those cases were collected in the department of plastic, reconstructive and burns surgery at the Al kortobi Hospital in tangier (Morocco) between mars 2021 and June 2022. The main outcome measures were demographics surgery type, clear margins histologically, surgical complications and local recurrence. Five patients were included in this study, 3 men and 2 women with an average age of 75 years old (60 to 90 years old), mean follow up was 5 months. All patients presented with a tumor in the eyelid or periocular skin, diagnosis included basal cell carcinoma in three patients and squamous cell carcinoma in the other two. Total orbital exenteration was performed in all patients, the cavity was filled with a temporalis muscle flap in four cases and with a local flap (type LLL= dufourmental flap) in one case. Clear margins tumor was obtained in all cases and no complications or recurrence were seen so far. Adjuvant radiation therapy was conducted on three cases. Reflecting the literature on the subject, exenteration aims at local control of disease invading the orbit that is potentially fatal or relentlessly progressive. We have promoted reconstruction using the temporal muscle flap thanks to its advantages such as a single operative step thus reducing operative morbidity, good skin coverage, fast healing and fewer postoperative complications. In term of our study, orbital exenteration retains its place in orbito-palpebral cancer surgery, while the temporal .......
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Adisthanaya, Surya, Febyan, Ida Ayu Ratna Dewi Arrisna Artha, and Putu Astawa. "Anatomic Acromioclavicular Joint Reconstruction Using Semitendinosus Graft with Internal Bracing in Chronic Acromioclavicular Joint Dislocation: Case Series." Orthopaedic Journal of Sports Medicine 11, no. 2_suppl (January 1, 2023): 2325967121S0090. http://dx.doi.org/10.1177/2325967121s00902.
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Introduction: Acromioclavicular joint dislocations represent a frequent condition, affecting a very specific and generally active population and accounting for around 9% of all shoulder injuries. Case Presentation: We present a series of patients who underwent AC Joint reconstruction using Semitendinosus graft with internal bracing. The beach chair position is used for acromioclavicular reconstruction surgery. In this technique, we restore the anatomy, reconstruct the coracoclavicular ligament, and reinforced the acromioclavicular ligament. And it is reliable for chronic acromioclavicular joint injury. At final follow up we found excellent results with average pain score of 1.6, and average ROM of 160° of forward flexion and abduction, 70° of external rotation, and internal rotation level at T11. Postoperative function also showed great improvements with average ASES of 85 points, an average Constant Score of 89 points. This technique also achieved acceptable radiographic results, with an average coracoclavicular distance increase of 1.4 mm Discussion & Conclusion: The loss of AC joint congruence with the Weaver Dunn procedure suggested that possibly the problem wasn’t only biological. This technique seems to be especially advantageous as it allows for an anatomic, biological, and minimally invasive procedure while avoiding some of the inconveniences described in other reports. Although demanding, it can be reproducibly performed arthroscopically, and good clinical outcomes should be expected.
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Zoccali, Carmine, Jacopo Baldi, Dario Attala, Alessandra Scotto di Uccio, Luca Cannavò, Gennaro Scotto, and Alessandro Luzzati. "3D-Printed Titanium Custom-Made Prostheses in Reconstruction after Pelvic Tumor Resection: Indications and Results in a Series of 14 Patients at 42 Months of Average Follow-Up." Journal of Clinical Medicine 10, no. 16 (August 12, 2021): 3539. http://dx.doi.org/10.3390/jcm10163539.
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Wide resection is currently considered the mainstay treatment for primary bone tumors. When the tumor is located in anatomically complex segments, 3D-Printed Titanium Custom-Made Prostheses (3DPTCMP) are possible reconstructive solutions. The aim of the present paper is to analyze indications, results and complications of a series of 14 patients who underwent pelvis reconstruction with 3DPTCMP after tumor removal from January 2015 to December 2019. Chondrosarcoma was the main histology; indications were tumors located in the acetabular area without enough residual bone to support a cup with an iliac stem, and tumors located near the sacrum-iliac joint. The margins were wide in 12 cases, and marginal and intralesional in one case each. In three cases, resection also included the sacrum-iliac joint, so a spine stabilization was performed and linked to the pelvic prosthesis; The average MSTS score was 46.3%; the 5-year local recurrence-free survival was 85.7%. Wound dehiscences were the main complication, resolved with multiple debridements; nevertheless, prosthesis removal was necessary in one case. Currently, the 3DPTCMP is an effective resource for reconstruction after resection of tumors located in the pelvis. Further studies are necessary to value long-term results; more strategies are necessary to try to reduce the infection rate and improve osteointegration.
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R, Fleischer, Chang V, and Culotta V. "A-068 Case Study: Neurodevelopment of Late Identification and Treatment of Nonsyndromic Multisutural Craniosynostosis." Archives of Clinical Neuropsychology 35, no. 6 (August 28, 2020): 859. http://dx.doi.org/10.1093/arclin/acaa068.068.
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Abstract Objective Craniosynostosis, the premature closure of cranial sutures, is frequently associated with intracranial hypertension, neurocognitive deficits, and neuromotor deficits. Younger age at treatment is associated with improved outcomes. This case study will expand upon the existing literature by characterizing the neurodevelopment of an individual whose nonsyndromic multisutural craniosynostosis was identified and treated late, when the patient was nearly three years old. Method A 7-year, 1-month old male with a history of bicoronal and sagittal craniosynostosis was seen for neuropsychological assessment. Diagnosis and cranial vault reconstruction occurred just before his third birthday. Evidence of increased intracranial pressure was found on presurgical CT scan, and by the appearance of his dura at surgery. His development after reconstruction was notable for articulation disorder, expressive language disorder, executive dysfunction, and adaptive skills deficits. Results Assessment revealed average non-verbal cognitive skills and low average verbal cognitive skills. Receptive language was below average. Exceptionally low scores were found on tasks of oromotor sequencing, verbal list learning, and immediate visual memory. Teacher ratings of executive functioning suggest below average skills. Measures of attention and impulsivity suggest mild weaknesses. Academically, he earned below average and exceptionally low scores on measures of reading and writing, with low average to average mathematics scores. Conclusions The neurodevelopment of children with late diagnosis/treatment of craniosynostosis is not well characterized and may confer increased risks. Late diagnosis is presumed to lead to more significant neurocognitive impairments due to the impact of prolonged intracranial pressure. Neuropsychological assessment and follow-up is critical for monitoring and intervention planning.
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D’Abbondanza, Josephine A., Ralph George, Sari Kives, and Melinda A. Musgrave. "Concurrent Prophylactic Mastectomy, Immediate Reconstruction, and Salpingo-Oophorectomy in High-Risk Patients: A Case Series." Plastic Surgery 28, no. 4 (June 4, 2020): 243–48. http://dx.doi.org/10.1177/2292550320928551.
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Purpose: There are limited data on coordinated breast and gynecological risk-reduction surgery for high-risk patients in Canada. Therefore, this study aims to evaluate the patient demographics, surgical details, and outcomes of prophylactic mastectomy (PM) with immediate reconstruction and bilateral salpingo-oophorectomy (BSO) in high-risk patients. Methods: We conducted a retrospective chart review at an academic center of patients who concurrently underwent PM with immediate reconstruction and laparoscopic BSO over a 7-year period (March 2010-February 2017) were identified. Results: A total of 16 patients underwent PM with immediate reconstruction and concurrent BSO. The mean age at the time of surgery was 46.2 ± 6.6 years. Thirteen (81%) patients were carriers of the BRCA1 or BRCA2 mutation. Two patients had prophylactic surgical therapy for BRCA1 mutation and 14 (87.5%) patients had prior oncological treatment. The most common type of procedures performed were skin-sparing, nipple-sparing mastectomy (56.2%) and reconstruction with acellular dermal matrix and implants (43.8%). All patients underwent laparoscopic BSO. The average combined case time was 282.5 ± 81.3 minutes with an average postoperative hospital stay of 1.3 ± 0.5 days. Six (37.5%) patients presented with 30-day postoperative complications, with higher rates in the alloplastic group. There were no gynecological complications. Conclusions: In conclusion, our results demonstrate that a combined multidisciplinary surgical approach did not increase length of stay or 30-day complication rates. Furthermore, concurrent risk-reducing strategies are an effective option for patients at high risk of breast or ovarian cancer.
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Mallik, Manoranjan, Satyajeet Ray, Ramesh Chandra Maharaj, Gaurav Kumar Singh, and Debi Prasad Nanda. "Evaluation of Results of Resection-Reconstruction Using Autologous Non-Vascularized Fibular Graft in Giant Cell Tumour Affecting Distal Radius - A Prospective Study." Journal of Evidence Based Medicine and Healthcare 7, no. 44 (November 2, 2020): 2534–38. http://dx.doi.org/10.18410/jebmh/2020/524.
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BACKGROUND Giant Cell Tumour (GCT) is a locally aggressive benign bone neoplasm characterized by proliferation of mononuclear stromal cells and many osteoclastlike multinucleated large giant cells affecting the epiphyseal segments of long bones mostly in females of 20 - 40 years age group. Distal radius is the third most common site of occurrence of GCT next to distal femur and proximal tibia. Resection or extended curettage remain the main modalities of treatment in Campanacci Grade I and II while en-bloc excision with reconstructive procedures, arthrodesis or amputation are the treatments of choice in Grade III with the latter two procedures leading to loss of joint function. Fibula being a non-weight transmitting bone of the lower limb, can be harvested in its proximal 1 / 3 rd and used for the reconstruction of the distal radius. In this study, we evaluate the functional and clinical results of resection and reconstruction using a nonvascularized fibula graft in the distal radius GCT. METHODS This is a prospective study of 20 patients diagnosed with GCT of distal radius either treated primarily at our institution or reviewed here after having been treated elsewhere. After confirmation of diagnosis, the patients underwent resection of the tumour and reconstruction of the distal radius using ipsilateral non vascularized fibula graft, fixed with dynamic compression plate. Follow-ups were done at regular intervals and radiological signs of graft healing, recurrence of tumour, wrist range of motion, and revised Musculoskeletal Tumour Rating Scale (MSTS) was used for assessing the functional outcome. RESULTS In our study, it was found that mostly females 13 (66.6 %) of the age group 30 - 35 yrs. were affected. The average grip strength achieved was 71 % (42 - 86 %) & average combined movements of 64 % (29 - 78 %) of contralateral normal side. Mean duration of union was 24 weeks (14 - 42 weeks). One case of non-union was seen which eventually achieved union with bone grafting. There was one case of soft tissue recurrence but the patient refused any further procedure. Complications were seen in 8 cases (41.6 %). We achieved excellent results in 15 (75 %), good in 2 (10 %), satisfactory in 2 (10 %) and poor in 1 (5 %) case. CONCLUSIONS We found that in GCT resection of the distal radius and reconstruction arthroplasty using autologous non-vascularized proximal fibular graft is useful in preserving the functional status as well as achieving satisfactory range of movement and grip strength with lesser chances of tumour recurrence. KEYWORDS Distal Radius, Giant Cell Tumour, Resection Reconstruction, Fibula
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Bodendorfer, Blake M., Laura E. Keeling, Evan M. Michaelson, Henry T. Shu, Nicholas A. Apseloff, James D. Spratt, Patrick S. Malone, and Evan H. Argintar. "Predictors of Knee Arthrofibrosis and Outcomes after Arthroscopic Lysis of Adhesions following Ligamentous Reconstruction: A Retrospective Case–Control Study with Over Two Years' Average Follow-Up." Journal of Knee Surgery 32, no. 06 (May 31, 2018): 536–43. http://dx.doi.org/10.1055/s-0038-1655741.
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AbstractArthrofibrosis can be a devastating complication after ligamentous knee reconstruction. Beyond early range of motion (ROM), manipulation under anesthesia (MUA) and arthroscopic lysis of adhesions (LOAs) are the most frequently employed interventions for the condition. There is a paucity of data regarding predictive factors of arthrofibrosis requiring MUA and LOA, and even less data regarding changes in validated patient-reported outcome measures following the procedure. A retrospective case–control study was performed at an academic, urban Level I trauma center of patients that developed arthrofibrosis requiring MUA and LOA following ligamentous reconstruction. The indication for LOA was failure to achieve a 90° arc of ROM by 6 weeks. Seventeen cases and 141 controls were identified. Follow-up for cases was 26.9 ± 17.1 months (mean ± standard deviation). Time from initial reconstruction to LOA was 75.2 ± 27.9 days. Cases had higher body mass indices by a mean of 2.9 (p = 0.024). The most significant risk factors for stiffness were concomitant anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner/lateral collateral ligament injury (odds ratio [OR], 17.08), knee dislocation (OR, 12.84), and use of an external fixator (OR, 12.81, 95% confidence interval [CI], 3.03–54.20) (all p < 0.0026). Mean Knee Injury and Osteoarthritis Outcome Scores, Western Ontario and McMaster Universities Osteoarthritis Indices, and International Knee Documentation Committee scores improved by 47.5, 50.5, and 47.3% (all p < 0.0038), respectively. All patients reported improvement in pain, with maximum daily pain scores improving by a mean of 4.1 points on the Numeric Pain Rating Scale (p < 0.001). Mean ROM arc improved by 38.8° (p < 0.001). All 17 cases were satisfied with the procedure. Twelve cases (70.59%) reported a full return to preinjury level of activity. No factors were identified that predicted success from the procedure, likely due to inadequate sample size. Arthrofibrosis following knee injury and ligamentous reconstruction can be predicted by the severity of injury and early intervention with MUA and arthroscopic LOA can lead to a satisfactory outcome for the patient.
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Walley, Kempland C., Tyler A. Gonzalez, Ryan Callahan, Aubree Fairfull, Evan Roush, Kaitlin L. Saloky, Paul J. Juliano, Gregory S. Lewis, and Michael C. Aynardi. "The Role of 3D Reconstruction True-Volume Analysis in Osteochondral Lesions of the Talus: A Case Series." Foot & Ankle International 39, no. 9 (April 27, 2018): 1113–19. http://dx.doi.org/10.1177/1071100718771834.
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Background: Evaluation and management of osteochondral lesions of the talus (OLTs) often warrant advanced imaging studies, especially in revision or cases with cystic defects. It is possible that orthopedic surgeons may overestimate the size and misinterpret the morphology of OLT from conventional computed tomography (CT), thereby influencing treatment strategies. The purpose of this study was to determine the utility of a novel means to estimate the true-volume of OLTs using 3D reconstructed images and volume analysis. Methods: With Institutional Review Board approval, an institutional radiology database was queried for patients with cystic OLTs that failed previous microfracture, having compatible CT scans and magnetic resonance imaging (MRI) between 2011 and 2016. Fourteen patients met inclusion criteria. Of these, 5 cases were randomly selected for 3D CT reconstruction modeling. Ten orthopedic surgeons independently estimated the volume of these 5 OLTs via standard CT. Then 3D reconstructions were made and morphometric true-volume (MTV) analysis measurements of each OLT were generated. The percent change in volumes from CT were compared to MTVs determined from 3D reconstructive analysis. Results: On average, the volume calculated by conventional CT scanner grossly overestimated the actual size of the OLTs. The volume calculated on conventional CT scanner overestimated the size of OLTs compared to the 3D MTV reconstructed analysis by 285% to 864%. Conclusions: Our results showed that conventional measurements of OLTS with CT grossly overestimated the size of the lesion. The 3D MTV analysis of cystic osteochondral lesions may help clinicians with preoperative planning for graft selection and appropriate volume while avoiding unnecessary costs incurred with overestimation. Level of Evidence: Level IV, case series.
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Wang, Shan, Jianhui Hu, Huiling Shan, Chun-Xiang Shi, and Weimin Huang. "Temperature Field Data Reconstruction Using the Sparse Low-Rank Matrix Completion Method." Advances in Meteorology 2019 (November 3, 2019): 1–10. http://dx.doi.org/10.1155/2019/3676182.
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Due to limited number of weather stations and interruption of data collection, the temperature field data may be incomplete. In the past, spatial interpolation is usually used for filling the data gap. However, the interpolation method does not work well for the case of the large-scale data loss. Matrix completion has emerged very recently and provides a global optimization for temperature field data reconstruction. A recovery method is proposed for improving the accuracy of temperature field data by using sparse low-rank matrix completion (SLR-MC). The method is tested using continuous gridded data provided by ERA Interim and the station temperature data provided by Jiangxi Meteorological Bureau. Experimental results show that the average signal-to-noise ratio can be increased by 12.5%, and the average reconstruction error is reduced by 29.3% compared with the matrix completion (MC) method.
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Kraft, Casey, and Gregory Pearson. "Axillary Hidradenitis Reconstruction Using a Dermal Regeneration Template." Wounds: a compendium of clinical research and practice 34, no. 2 (2022): 43–46. http://dx.doi.org/10.25270/wnds/110121.01.
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Introduction. Hidradenitis suppurativa can be a debilitating condition, particularly in the pediatric population. Axillary hidradenitis can be particularly challenging because of the risk of scar contracture and limited range of motion after definitive resection and reconstruction. A dermal regeneration template (DRT) and skin grafting have been used to reduce scar contracture in other areas of the body and may benefit this population. Objective. This case series retrospectively reviewed and evaluated outcomes using DRT and skin grafting for axillary hidradenitis reconstruction to report the authors’ initial experience. Materials and Methods. After institutional review board approval, a retrospective review was conducted of a single surgeon’s experience for all patients undergoing axillary hidradenitis resection and immediate reconstruction with DRT and skin grafting from 2015 through 2018. Preoperative characteristics, surgical details, and postoperative results were collected. Results. Five patients undergoing 7 procedures were eligible for inclusion. The average age at the time of surgery was 18.2 years. Patients underwent an average of 4.9 negative pressure wound therapy changes prior to skin grafting. No complications, DRT loss, or skin graft loss occurred. All patients were reported to have normal range of motion of the surgically managed extremity after skin grafting. The average follow-up was 273.4 days after the last procedure. As of this writing, no patients had experienced any recurrence of hidradenitis in the surgically managed axilla. Conclusions. The use of DRT and subsequent skin grafting for the definitive management of axillary hidradenitis resulted in no recurrence and full range of motion of the affected extremity without complications. Surgeons should consider using this method of reconstruction for axillary hidradenitis, particularly in the pediatric population.
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Holden, Philip B., H. John B. Birks, Stephen J. Brooks, Mark B. Bush, Grace M. Hwang, Frazer Matthews-Bird, Bryan G. Valencia, and Robert van Woesik. "BUMPER v1.0: a Bayesian user-friendly model for palaeo-environmental reconstruction." Geoscientific Model Development 10, no. 1 (February 1, 2017): 483–98. http://dx.doi.org/10.5194/gmd-10-483-2017.
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Abstract. We describe the Bayesian user-friendly model for palaeo-environmental reconstruction (BUMPER), a Bayesian transfer function for inferring past climate and other environmental variables from microfossil assemblages. BUMPER is fully self-calibrating, straightforward to apply, and computationally fast, requiring ∼ 2 s to build a 100-taxon model from a 100-site training set on a standard personal computer. We apply the model's probabilistic framework to generate thousands of artificial training sets under ideal assumptions. We then use these to demonstrate the sensitivity of reconstructions to the characteristics of the training set, considering assemblage richness, taxon tolerances, and the number of training sites. We find that a useful guideline for the size of a training set is to provide, on average, at least 10 samples of each taxon. We demonstrate general applicability to real data, considering three different organism types (chironomids, diatoms, pollen) and different reconstructed variables. An identically configured model is used in each application, the only change being the input files that provide the training-set environment and taxon-count data. The performance of BUMPER is shown to be comparable with weighted average partial least squares (WAPLS) in each case. Additional artificial datasets are constructed with similar characteristics to the real data, and these are used to explore the reasons for the differing performances of the different training sets.
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Sajovic, Matjaz, Gorazd Lesnicar, and Mojca Z. Dernovsek. "Septic arthritis of the knee following anterior cruciate ligament reconstruction." Orthopedic Reviews 1, no. 1 (April 29, 2009): 3. http://dx.doi.org/10.4081/or.2009.e3.
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Septic arthritis of the knee is a rare complication after arthroscopic anterior cruciate ligament reconstruction, and the most appropriate treatment is unclear. All case series reported so far have been retrospective, and case numbers of septic arthritis have ranged from 4 to 11. From a consecutive case series of 1,283 patients who underwent arthroscopic anterior cruciate ligament reconstruction between January 1997 and May 2008, we report on 3 patients (0.23%) with post-operative septic arthritis. All patients had acute infection (≤ 2 weeks), bacterial cultures showed Staphylococcus species in 2 patients, while the bacterial culture was negative in the third. All of them underwent immediate arthroscopic debridement and lavage with continuous irrigation, as well as antibiotic treatment. The results were evaluated with physical and radiographic examination, functional testing, KT-2000, Lysholm and Tegner scales. The infection was successfully eradicated without further surgical treatment and the ligament graft was retained in all patients. Follow-up, at an average of 33 months, revealed that the patients had full symmetric knee range of motion and no effusion. The average Lysholm score was 91 points. In the patient with a lower subjective score, radiographs demonstrated patellofemoral joint-space narrowing, which is most probably in correlation with his anterior knee pain problems and lower activity level. The 134 N KT-2000 arthrometer side-to-side differences averaged 13 mm. Their performance in the single-legged hop test gave excellent results. The goals of treatment for septic arthritis after anterior cruciate ligament reconstruction are, primarily, to protect the articular cartilage and, secondly, to protect the graft. Through early diagnosis and prompt treatment, the infection can be successfully eradicated, with stability of the knee and full range of motion achieved.
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Arora, Viresh, Faisal Ashfaq, and Atif Rafique. "Is reconstruction of composite defects of nose and cheek following tumor excision utilizing subunit principle the best?" International Journal of Otorhinolaryngology and Head and Neck Surgery 7, no. 5 (April 23, 2021): 721. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20211563.
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<p class="abstract"><strong>Background:</strong> Composite defects of nose and cheek are best stage reconstructed with separate nose and cheek flaps to recreate a blended nose-cheek junction, achieved by cheek advancement flap for cheek and forehead flap or local grafts for the nasal defect. This article analyses whether reconstruction of defects utilizing well-known subunit principle is cosmetically the best?</p><p class="abstract"><strong>Methods:</strong> Case records of fifteen patients of nasal cancers extension into the cheek from January 2011 to December 2015 were analyzed retrospectively.</p><p class="abstract"><strong>Results:</strong> Out of fifteen patients 8 were men and 7 women, two patients had SCC, rest had BCC. Average size of defect was 4.5 cm. Modified Imre’s cheek advancement flaps was used in all to reconstruct cheek defects while paramedian forehead flap was used for nasal reconstruction in 13 patients, skin graft and nasal advancement flap in one each. Eight patients underwent single stage reconstruction while seven with full thickness nasal defects had a delayed reconstruction. 13 patients rated their final appearance as satisfactory, while surgeon rated 12 patients with well-blended nose-cheek junction as satisfactory and lateral migration of junction being unsatisfactory. Alar retraction was observed in two patients with full thickness nasal defects. Two patients who underwent inner nasal lining reconstruction developed wound dehiscence while simultaneous reconstruction of nose and cheek was performed.</p><p class="abstract"><strong>Conclusions:</strong> Subunit principle application for composite nose and cheek results in symmetrical nose-cheek junction and appears excellent technique in achieving a satisfactory aesthetic outcome. Optimal results in full thickness nasal defects are achieved where reconstructing is delayed.</p>
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Hassan, Syahir, Md Arad Jelon, Nur Ikram Hanim Abd Rahim, Mohammad Adzwin Yahya, and Norhayati Omar. "Fast and economical protocol for in-house virtual planning and 3D-printed surgical templates in mandibular reconstruction." Journal of 3D Printing in Medicine 4, no. 2 (June 2020): 83–90. http://dx.doi.org/10.2217/3dp-2019-0026.
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In this work, a case series consisting of mandibular reconstruction with free fibula flap in ameloblastic carcinoma, pathological mandibular fracture and recontouring of mandibular angle hyperplasia that were treated successfully using fast and economical in-house virtual planning and 3D-printing protocol has been presented. Pre-operatively, the design of the reconstructed mandibular model and surgical templates were carried out, with the help of two types of free software. As the next step, all designed 3D hardware tools were printed using affordable fused deposition modeling desktop 3D printer. A 3D-printed reconstructed mandibular model was used for titanium plate bending. Our findings have illustrated that it necessitates an average of 5 h 29 min per case from virtual planning stage until the 3D printing of all 3D hardware tools is completed. The average cost for 3D-printed hardware tools and titanium plate per case is only $203.42.
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Steiner, Stephan Alois, Riccardo Schweizer, Holger Klein, Matthias Waldner, Pietro Giovanoli, and Jan A. Plock. "Abdominal, perineal, and genital soft tissue reconstruction with pedicled anterolateral thigh perforator flaps." European Journal of Plastic Surgery 44, no. 5 (May 26, 2021): 669–77. http://dx.doi.org/10.1007/s00238-021-01830-4.
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Abstract Background Pedicled perforator flaps have become a contemporary alternative to muscle flaps for soft tissue reconstruction as they have reduced donor site morbidity, avoid the need for microsurgical transfer, and are versatile and reliable. The anterolateral thigh (ALT) flap was first introduced as a free flap and has since gained popularity as a pedicled flap. Here we review our experience using pedicled ALT flaps for regional soft tissue reconstruction. Methods We retrospectively reviewed all patients who underwent loco-regional soft tissue reconstruction using pedicled ALT flaps between March 2014 and October 2018, with the goal of identifying potential applications of pedicled ALT flaps. The following aspects of each case were reviewed: patient demographics, defect location and size, comorbidities such as previous radiotherapy, flap details, clinical follow-up, and postoperative complications. Results Our analysis demonstrates the versatility of pedicled ALT flaps in a variety of indications to successfully cover large abdominal, perineal, and genital soft tissue defects. Depending on the patient’s needs to achieve more bulk or stability in the reconstruction, the ALT flap was individually tailored with underlying muscle or fascia. The average follow-up was 7 months (range: 3–13 months). Conclusions Pedicled ALT flaps are a valuable reconstructive option for soft tissue defects located within the pedicle’s range, from the lower abdomen to the perianal region. These flaps are usually raised from a non-irradiated donor site and are sufficient for covering extensive soft tissue defects. Three-dimensional reconstruction of the defect using pedicled ALT flaps allows for anatomical function and minor donor sites. Level of evidence: Level IV, therapeutic study.
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Moyle, Madeleine, and John F. Boyle. "A method for reconstructing past lake water phosphorus concentrations using sediment geochemical records." Journal of Paleolimnology 65, no. 4 (February 5, 2021): 461–78. http://dx.doi.org/10.1007/s10933-021-00174-0.
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AbstractAn existing steady state model of lake phosphorus (P) budgets has been adapted to allow reconstruction of long-term average historic lake water total phosphorus (TP) concentrations using lake sediment records of P burial. This model can be applied without site-specific parameterisation, thus potentially having universal application. In principle, it is applicable at any site where there is both a sediment P burial record and knowledge of the current water budget, although we advise caution applying it to problematic sediment records. Tested at six published case study sites, modelled lake water TP concentrations agree well with water-quality monitoring data, and limited testing finds good agreement with wholly independent diatom inferred lake water TP. Our findings, together with a review of the literature, suggest that well preserved lake sediments can usefully record a long-term average P burial rate from which the long-term mean lake water TP can be reliably estimated. These lake water TP reconstructions can provide meaningful site-specific reference values to support decision making in lake eutrophication management, including establishing targets for lake restoration.